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Social Services

Volume 502: debated on Tuesday 8 December 2009

To ask the Secretary of State for Health if he will estimate the cost of implementing the provisions of personal care as set out in the Personal Care at Home Bill using a definition of personal care which includes the services listed in paragraph 4.9 of the Impact Assessment for the Personal Care at Home Bill. (304787)

It is not appropriate to do so, as Instrumental Activities of Daily Living are outside the definition of Personal Care as set out under the draft regulations being made under sections 8 and 20 of the Health and Social Care Act 2008.

To ask the Secretary of State for Health with reference to paragraph 4.6 of the Impact Assessment for the Personal Care at Home Bill, if he will publish by the end of 2009 (a) the model and (b) the costing produced by the model. (304788)

As stated in the Impact Assessment, work on this is ongoing. We are currently modelling costs and will be consulting more widely with stakeholders to test those costing assumptions. The consultation will run until 23 February 2010.

To ask the Secretary of State for Health with reference to paragraph 5.2 of the Impact Assessment for the Personal Care at Home Bill, whether the expectation of costs of providing personal care reflects an expected use in (a) unit costs, (b) costs to councils or (c) other costs. (304789)

The point being made in paragraph 5.2 of the Impact Assessment is that the ‘do nothing' option will not impose any additional costs beyond those currently met by councils or individuals. In addition, those individuals who currently make a means-tested contribution to their care costs will not, under the ‘do nothing’ option, be protected against any future increases in the care charges levied by councils.

To ask the Secretary of State for Health with reference to table 2 and Annex 1 of the Impact Assessment for the Personal Care at Home Bill, if he will publish the logistic model used to calculate each individual's need for formal care; and from what source data were derived to populate that model. (304796)

The logistic regression model referred to in Annex 1 is used to estimate a continuous measure of need for individuals 65 and over in the third wave of the English longitudinal study of ageing (ELSA). The data used to populate the model was from the third wave of ELSA. The specification of the model is as follows:

logit(p) = b0 + b1X1 + b2X2 + b3X3 + b4X4 + b5X5 + b6X6 + b7X7 + b8X8 + b9X9

where p is the probability of receiving formal care (either state, private or voluntary sector funded)

b0 is a constant term

b1 to b9 are co-efficients on the independent variables X1 to X9

X1 is the individual's age in years

X2 is the square of the individual's age in years

X3 is 1 if the individual has difficulty with dressing and 0 if not

X4 is 1 if the individual has difficulty with walking and 0 if not

x5 is 1 if the individual has difficulty with bathing and 0 if not

x6 is 1 if the individual has difficulty with eating and 0 if not

x7 is 1 if the individual has difficulty with going to bed and 0 if not

x8 is 1 if the individual has difficulty with going to the toilet and 0 if not

x9 is 1 if the individual lives alone and 0 if not

To ask the Secretary of State for Health with reference to Annex A of the Impact Assessment for the Personal Care at Home Bill, from what source the assumption that home care represents 74 per cent. of overall community care costs and personal care represents 85 per cent. of that is derived. (304798)

The figure of 74 per cent. is derived from Personal Social Services EX1 expenditure data for older people and estimated by expressing the expenditure on home care services in terms of overall expenditure. In the absence of data on the share of home care costs represented by personal care we have made a conservative, illustrative assumption of 85 per cent.

To ask the Secretary of State for Health with reference to paragraph 5.9 of the Impact Assessment for the Personal Care at Home Bill, what methodology was used to reach the estimate that a further 108,964 persons already have their personal care needs met free of charge; and what the equivalent estimated figure is for (a) 2015, (b) 2020, (c) 2025 and (d) 2030. (304800)

The Personal Social Services Research Unit (PSSRU)'s micro-simulation model for older people estimated a volume of fair access to care services (FACS) critical individuals who already receive state-funded care at home.

This figure was broken down into those who are FACS critical and report difficulty with four or more activities of daily living (ADLs) by using the information in the English longitudinal study of ageing, which is presented in table 1 of the Impact Assessment for the Personal Care at Home Bill. The 108,964 represents the residual volume of FACS critical individuals from PSSRU's model—i.e. those reporting difficulty with less than four ADLs.

The figures in the impact assessment cover the period from October 2010 to the end of 2012-13. Estimating beyond this point is problematic because of the uncertainties involved. For instance, the proposals here are intended as a step towards a fully integrated national care service, at which point a different set of assumptions may need to be applied.

To ask the Secretary of State for Health for what reasons the net present value costs identified in table 3 of the Impact Assessment for the Personal Care at Home Bill are inconsistent with the present value costs identified on page 2. (304801)

Table 3 of the impact assessment shows the net present value costs of extending the offer of free personal care at home to those in highest need—i.e. individuals who are estimated to be fair access to care services critical and who report difficulty with four or more activities of daily living. The net present value costs reported in the summary sheet on page 2 also include the costs of offering re-ablement services, estimated to be £130 million in 2011-12.

To ask the Secretary of State for Health what the inherent uncertainties referred to in paragraph 5.10 of the Impact Assessment for the Personal Care at Home Bill are. (304802)

The uncertainties are those aspects of people’s behaviour that will change as a result of the introduction of these proposals. An accurate forecast of these therefore cannot be made. The impact of the policy will be reviewed after 12-18 months to ensure that it is being applied properly and that there are no perverse incentives.

To ask the Secretary of State for Health with reference to paragraph 5.11 of the Impact Assessment for the Personal Care at Home Bill, what his Department's (a) minimum and (b) maximum estimate of re-ablement costs are. (304803)

We understand that there is wide variability in costs of re-ablement in different councils. The Impact Assessment for the Personal Care at Home Bill makes clear that the £1,000 cost of re-ablement per person is an assumption—paragraph 5.15 states, “If we assume the cost of a package of re-ablement is £1,000 per person...”—and its derivation is clearly and transparently stated in Annex B. Given the uncertainties associated with alternative cost figures and the relatively conservative stance taken with regard to potential benefits, the £1,000 per person estimate used in the impact assessment is not considered to be unreasonable.

To ask the Secretary of State for Health pursuant to paragraph 5.12 of the Impact Assessment for the Personal Care at Home Bill, if he will place in the Library a copy of the model referred to. (304804)

The model referred to in paragraphs 5.12, 5.13 and Annex B of the Impact Assessment is still under development. For this reason, its output has not been incorporated into any of the figures reported in the Impact Assessment. The model will continue to be updated and refined as more information becomes available.

To ask the Secretary of State for Health with reference to the Impact Assessment for the Personal Care at Home Bill; whether he plans to make individuals eligible for more than one package of re-ablement funded by the taxpayer. (304805)

This is something that we invite comments on as part of the consultation, ‘Personal Care at Home: a consultation on proposals for regulation and guidance’, a copy of which has already been placed in the Library. There are currently no proposals to restrict packages of re-ablement. It will be for councils to determine who might benefit from this intervention and whether it is appropriate to repeat this at a later date.

To ask the Secretary of State for Health with reference to paragraph 4.6 of the Impact Assessment for the Personal Care at Home Bill, in what cases he expects the indicative sum to be administered (a) by the council and (b) through an individual budget or direct payment. (304812)

It will be for individuals to choose whether they wish the council to provide services through a personal budget on their behalf or whether they wish to take a direct payment and arrange services for themselves.

To ask the Secretary of State for Health with reference to the Impact Assessment for the Personal Care at Home Bill, what re-ablement schemes he expects to be available; and what home additions might be made under such schemes. (304814)

This would be a matter for local discretion based on the assessment of an individual's needs. In our consultation, ‘Personal Care at Home: a consultation on proposals for regulations and guidance’, we suggest that this could include physiotherapy, occupational therapy, installation of telecare or adaptations to the house. A copy of the document has already been placed in the Library.

To ask the Secretary of State for Health with reference to Annex B of the Impact Assessment for the Personal Care at Home Bill, how the average number of hours of personal care per week of 6.54 was calculated; and whether the (a) calculation and (b) figure of 6.54 hours has been published by his Department previously. (304815)

The model referred to in paragraphs 5.12, 5.13 and Annex B of the Impact Assessment is still under development. For this reason, its output has not been incorporated into any of the figures reported in the Impact Assessment. The model will continue to be updated and refined as more information becomes available.

The assumption used for the average number of hours of personal care per week of 6.54 was used for illustrative purposes. It is derived by converting the cost and volume estimates from the Personal Social Services Research Unit's (PSSRU) micro-simulation model for older people into an equivalent weekly number of hours. Although this figure has not been previously published, a reference to a technical paper giving further details of PSSRU's micro-simulation model is given in Annex A of the Impact Assessment.

To ask the Secretary of State for Health with reference to paragraph 5.13 of the Impact Assessment for the Personal Care at Home Bill, what his Department's (a) minimum and (b) maximum estimates of net savings are. (304816)

The model referred to in paragraphs 5.12, 5.13 and Annex B of the impact assessment is still under development. For this reason, its output has not been incorporated into any of the figures reported in the Impact Assessment. The model will continue to be updated and refined as more information becomes available.

To ask the Secretary of State for Health (1) with reference to Table 4 of the Impact Assessment for the Personal Care at Home Bill, what methodology was used to calculate each estimate; (304837)

(2) with reference to paragraph 5.21 of the Impact Assessment for the Personal Care at Home Bill, on what grounds he made his illustrative assumptions; and when the further work in paragraph 5.23 will be (a) undertaken and (b) published;

(3) with reference to the Impact Assessment for the Personal Care at Home Bill, what methodology was used to calculate the figure given for total benefit.

To ask the Secretary of State for Health what plans he has to collect centrally data relating to (a) Fair Access to Care Services critical people and (b) reablement. (304845)

The consultation document, “Personal Care at Home: a consultation on proposals for regulations and guidance”, has sought views from councils on what data may be required and how they might be collected. A copy of the document has already been placed in the Library.

To ask the Secretary of State for Health whether he plans to operate his policy on free personal care as set out in the Personal Care at Home Bill by means of individual budgets. (304846)

The consultation document, “Personal Care at Home: a consultation on proposals for regulations and guidance”, makes it clear that we intend that the free personal care component would form part of a personal budget and could be used flexibly to meet agreed outcomes. A copy of the document has already been placed in the Library.

To ask the Secretary of State for Health pursuant to the Explanatory Notes for the Personal Care at Home Bill, whether external legal advice was sought on the effects on human rights of the proposals in the Personal Care at Home Bill. (304849)

Legal advice relating to legislation is generally provided by departmental lawyers. No external legal advice was sought on this matter.

To ask the Secretary of State for Health whether children would be eligible to receive taxpayer-funded personal care under his proposals for personal care as set out in the Personal Care at Home Bill. (304850)

These proposals are for adults over the age of 18. Children will continue to be covered, as they are now, under separate legislation.

To ask the Secretary of State for Health with reference to paragraph 7.10 of the Impact Assessment for the Personal Care at Home Bill, what (a) events and (b) submissions have contributed to the consultation being undertaken on effects on particular regions; and if he will publish (i) the responses to and (ii) the outcomes of this consultation by the end of December 2009. (304854)

Comments on the impact of the policy on different councils are invited in the consultation document, “Personal Care at Home: a consultation on proposals for regulations and guidance”, a copy of which has already been placed in the Library. The consultation will run until 23 February and a response will be published following that.

To ask the Secretary of State for Health with reference to paragraph 7.10 of the Impact Assessment for the Personal Care at Home Bill, how many beneficiaries he expects there to be in each local authority area in England. (304858)

To ask the Secretary of State for Health how many and what proportion of people assessed as critical under the Fair Access to Care Services (FACS) eligibility framework in each of the last five years were subsequently assigned to another FACS band. (304859)

To ask the Secretary of State for Health whether free personal care under his proposed changes to the care system would continue if a person assessed as critical under the Fair Access to Care Services eligibility framework was subsequently assessed at a different level. (304860)

Councils are under a duty to regularly assess an individual’s needs and adjust the support available to them as needs change. Under our proposals, if an individual should no longer meet the criteria they would no longer be eligible for free personal care.

To ask the Secretary of State for Health with reference to the Impact Assessment for the Personal Care at Home Bill, what assessment he has made of the effects of enactment of his legislative proposals on competition in the care home sector. (304946)

This policy is designed to support individuals who want to live at home for as long as possible where this is what they wish. With an ageing population there will continue to be a need for residential care, and this will remain an appropriate setting in which to meet some people’s care needs.

To ask the Secretary of State for Health with reference to the Impact Assessment for the Personal Care at Home Bill, for what reasons the impact assessment does not include costings for policy enforcement by local authorities. (304947)

An estimate of the associated administrative costs of the policy for local authorities is included in table 2 of the impact assessment for the Personal Care at Home Bill and these have been estimated at £27 million.

To ask the Secretary of State for Health what assessment his Department has made of the merits of a national resource allocation system for the provision of free personal care; and if he will make a statement. (305028)

The Department has looked at the merits of a national resource allocation system (RAS). The range of provision varies substantially between different local authorities, which makes a national RAS unrealistic at the present time.

As part of the Regulations and guidance which will inform the working of the Personal Care at Home Bill, the Department plans to develop a national assessment tool for all authorities to use to ensure a consistent application of the eligibility criteria for free personal care at home. The consultation document, Personal Care at Home: a consultation on proposals for regulations and guidance, asks for comments on three options as to how available resources and funding might be allocated to individuals by councils. The consultation document has already been placed in the Library.

To ask the Secretary of State for Health what assessment has been made of the capacity of local authorities to provide free personal care under the terms of the Personal Care at Home Bill; and if he will make a statement. (305029)

The plans for free personal care at home for those with the highest care needs should build on the most innovative practices already adopted by many local authorities and primary care trusts. We have already begun engaging with local authority stakeholders to discuss the workings of the scheme, and councils are invited to respond to the consultation document, “Personal Care at Home: a consultation on proposals for regulations and guidance”. The consultation document has already been placed in the Library.